Outcomes and predictive factors after cataract surgery in patients with neovascular age-related macular degeneration. The Fight Retinal Blindness! Project

Purpose: To evaluate outcomes and predictive factors of visual acuity (VA) change after cataract surgery in patients being treated for neovascular age-related macular degeneration (nAMD). Design: Retrospective, matched case-control study. Methods: We studied eyes undergoing cataract surgery that had been tracked since they first started treatment for nAMD. These eyes were compared with a cohort of unoperated phakic eyes being treated for nAMD (three per case) matched for treatment duration before cataract surgery, baseline VA, age and length of follow-up. Results: We included 124 patients that had cataract surgery and 372 matched controls. The mean (95% CI) VA gained was 10.6 letters (7.8, 13.2; P < 0.001) 12 months following surgery; 26.0% had gained ≥ 3 lines and 1.6% had lost ≥ 3 lines of VA. Visual acuity (mean [SD]) 12 months after surgery was higher in eyes that had cataract extraction compared with controls (65.8 [17.1] vs. 61.3 [20.8] letters respectively, P = 0.018). The proportion of visits where the choroidal neovascular (CNV) lesion was graded active and the mean number of injections were similar before and after surgery (P = 0.506 and P = 0.316, respectively), while both decreased in the control group, suggesting that surgery modestly increased the level of activity of the CNV lesion. Mean [SD] VA prior to surgery was lower in eyes that gained ≥15 letters compared with eyes that gained 0-14 letters (40.2 [21.4] vs. 62.1 [15.1], P < 0.001). Patients undergoing cataract surgery within the first 6 months of anti-VEGF therapy were more likely to lose rather than gain vision (20.8% lost vision vs. 12.8% and 4.4% gaining ≥15 or 0-14 letters respectively, P = 0.023). Age, receiving an injection at least 2 weeks before surgery, and the CNV lesion type had no discernible association with VA outcomes. Conclusions: We found evidence of a modest effect of cataract surgery on CNV lesion activity in eyes being treated for nAMD. Despite this, visual outcomes were reassuringly good. Cataract surgery within 6 months of starting treatment for nAMD should be avoided if possible.The Fight Retinal Blindness Project was supported by a grant from the Royal Australian NZ College of Ophthalmologists Eye Foundation (2007-2009), a grant from the National Health and Medical Research Council, Australia (NHMRC 2010-2012) and a grant from the Macula Disease Foundation, Australia. Mark Gillies is a Sydney Medical Foundation Fellow and is supported by an NHMRC practitioner fellowship. Daniel Barthelmes was supported by the Walter and Gertud Siegenthaler Foundation Zurich, Switzerland and the Swiss National Foundation. Vincent Daien was supported by the research grant of the French Society of Ophthalmology and by Servier. Funding was also provided by Novartis and Bayer

Treat-and-Extend Versus Pro re nata Regimens of Ranibizumab and Aflibercept in Neovascular Age-Related Macular Degeneration: A Comparative Study from Routine Clinical Practice

INTRODUCTION: Anti-vascular endothelial growth factor (VEGF) is generally given using pro re nata or "treat-and-extend" (T&E) regimens for neovascular age-related macular degeneration (nAMD). Randomized clinical trials have reported that T&E is superior to Pro re nata (PRN), but results from clinical trials may not always be replicated in clinical practice. Real-world data comparing T&E and PRN regimens for nAMD are limited. The objective of this work was to report 24-month outcomes of PRN versus T&E regimens for ranibizumab and aflibercept to treat nAMD in routine clinical practice. METHODS: We conducted a retrospective analysis of data from a prospectively designed observational outcomes registry, the Fight Retinal Blindness! Project (FRB). Treatment-naïve eyes starting nAMD treatment with at least three injections using a T&E or PRN regimen were tracked by using the FRB. The primary outcome was the mean change in visual acuity (VA) measured by the number of letters read on a logarithm of the minimum angle of resolution chart at 2 years versus baseline. The secondary outcome was the number of injections at 2 years. RESULTS: From January 1, 2015 to January 31, 2019, 3313 eyes from 2948 patients with nAMD were included: 1243 eyes from 1065 patients were classified as PRN and 2070 eyes from 1935 patients started a T&E regimen. At 24 months, patients on the T&E regimen experienced significantly greater mean (95% confidence interval) improvement in VA than those on PRN (+ 4.2 [3.1, 5.2] vs. + 1.3 [0.1, 2.6] letters; p < 0.001), with more injections (14.9 standard deviation(SD) 4.3) vs. 9.8(SD 4.3); p < 0.001). CONCLUSIONS: Eyes treated with a T&E regimen had better VA outcomes from VEGF inhibitors than eyes treated PRN. This large real-world data assessment supports previous data from randomized clinical trials that the T&E regimen delivers better outcomes than PRN

Incidence and Outcomes of Infectious and Noninfectious Endophthalmitis after Intravitreal Injections for Age-Related Macular Degeneration

International audiencePURPOSE:To assess the incidence, cumulative rate, and long-term outcomes of infectious and noninfectious endophthalmitis after intravitreal injections (IVTs) of anti-vascular endothelial growth factor (VEGF) agents.DESIGN:Database study, prospectively designed.PARTICIPANTS:Treatment-naïve eyes with neovascular age-related macular degeneration (nAMD) tracked by the Fight Retinal Blindness! (FRB!) registry that commenced anti-VEGF therapy between January 1, 2006, and November 30, 2016.METHODS:Cumulative rate of endophthalmitis and survival curves were measured using Cox-proportional hazards models. Locally weighted scatterplot smoothing curves were used to display visual acuity (VA).MAIN OUTCOME MEASURES:Incidence and cumulative rate of endophthalmitis, and change in VA 12 months after endophthalmitis.RESULTS:Infectious endophthalmitis developed in 18 of 88 150 injections (1/4897 injections [0.020%]; 95% confidence interval [CI], 0.012-0.032) with no difference found between types of anti-VEGF medications (P = 0.896). The cumulative rate of infectious endophthalmitis per patient was 0.055%, 0.183%, 0.360%, 0.360%, 0.555%, and 0.843% after 10, 20, 30, 40, 50, and 60 IVTs, respectively. However, the "risk" of infectious endophthalmitis did not increase with each successive injection (P = 0.202). Noninfectious endophthalmitis developed in 11 of 88 150 injections (1/8013 injections [0.012%]; 95% CI, 0.006-0.022). The cumulative rate of noninfectious endophthalmitis per patient was 0.087% and 0.228% after 10 and 20 IVTs, respectively, and then remained stable up to 60 IVTs. The incidence of noninfectious endophthalmitis was higher for bevacizumab (8/9931, 0.081%) compared with ranibizumab (3/54 776, 0.005%; P = 0.005) and aflibercept (0/23 425; P = 0.016), and no differences were observed between ranibizumab and aflibercept (P = 1.0). The 12-month VA in infectious and noninfectious endophthalmitis was within ±2 lines of before endophthalmitis in 53% and 75% of eyes, respectively; a loss >2 lines was observed in 31% and 25% of eyes, respectively.CONCLUSIONS:The incidences of infectious and noninfectious endophthalmitis after IVT were low, and the risk did not increase with each successive injection. We found higher rates of noninfectious endophthalmitis with bevacizumab compared with ranibizumab or aflibercept. Three quarters of cases with infectious and two thirds of cases with noninfectious endophthalmitis retained vision within 10 letters of the pre-endophthalmitis level

Does HbA1c Level or Glomerular Filtration Rate Affect the Clinical Response to Endothelial Growth Factor Therapy (Ranibizumab or Aflibercept) in Diabetic Macular Edema? A Real-Life Experience

Introduction: Anti-vascular endothelial growth factor (VEGF) therapy is the first-line treatment for diabetic macular edema (DME). We investigated the effect of initial glycosylated hemoglobin (HbA1c) level and glomerular filtration rate (GFR) on treatment outcomes in patients with DME receiving anti-VEGF injections in routine clinical practice. Methods: A retrospective analysis of data from the prospective, multi-center, observational Fight Retinal Blindness! registry was performed. A total of 178 eyes with DME treated with anti-VEGF agents (ranibizumab or aflibercept) from 1 January 2010 to 31 March 2019 were enrolled in the analysis, with the long study period to allow for up to 24 months of follow-up. Data for eyes were tracked in the Fight Retinal Blindness! registry, and clinical parameters were collected by using local software. Changes in visual (best-corrected visual acuity [BCVA], in letters) and anatomic outcomes (central subfield thickness [CST], in microns) between subgroups of patients according to baseline HbA1c level (≤ 7% vs. > 7%) and GFR (> vs. ≤ 60 ml/min/m2 at 24 months were assessed. Results: The multivariate adjusted mean improvement in BCVA at 24 months of treatment was + 5.2 and + 6.8 letters in subgroups with baseline HbA1c level ≤ 7% and > 7%, respectively (p = 0.541), and + 6.9 and + 6.4 letters in subgroups with GFR > 60 and 7%, respectively (p = 0.505), and - 85 and - 115 µm in subgroups with baseline GFR > 60 and ≤ 60 ml/min/1.73 m2, respectively (p = 0.130). Conclusion: These results seem to indicate that visual and anatomical improvement in patients receiving intravitreal VEGF inhibitors for DME are independent of baseline HbA1c level and GFR, leading to the conclusion that high HbA1c levels or low GFR should not dictate injection timing in routine clinical practice. This study offers valuable insights for ophthalmologists, enabling a personalized treatment approach and optimizing DME patient outcomes

Incidence, Risk Factors, and Outcomes of Rhegmatogenous Retinal Detachment after Intravitreal Injections of Anti-VEGF for Retinal Diseases: Data from the Fight Retinal Blindness! Registry

Purpose: To report the estimated incidence, probability, risk factors, and 1-year outcomes of rhegmatogenous retinal detachment (RRD) in eyes receiving intravitreal injections (IVTs) of VEGF inhibitors for various retinal conditions in routine clinical practice. Design: Retrospective analysis of data from a prospectively designed observational outcomes registry: the Fight Retinal Blindness! Participants: Eyes of patients starting IVTs of VEGF inhibitors (ranibizumab, aflibercept, or bevacizumab) for neovascular age-related macular degeneration, diabetic macular edema, or retinal vein occlusion from January 1, 2006, to December 31, 2020. All eyes that developed RRD within 90 days of IVTs were defined as cases with RRD and were matched with control eyes. Methods: Estimated incidence, probability, and hazard ratios (HRs) of RRD were measured using Poisson regression, Kaplan-Meier survival curve, and Cox proportional hazards models. Locally weighted scatterplot smoothing curves were used to compare visual acuity (VA) between cases and matched controls. Main outcome measures: Estimated incidence of RRD. Results: We identified 16 915 eyes of 13 792 patients who collectively received 265 781 IVTs over 14 years. Thirty-six eyes were reported to develop RRD over the study period. The estimated incidence (95% confidence interval [CI]) per year per 1000 patients and per 10 000 injections was 0.77 (0.54-1.07) and 1.36 (0.95-1.89), respectively. The probability of RRD did not significantly increase at each successive injection (P = 0.95) with the time of follow-up. Older patients (HR [95% CI] = 1.81 [1.21-3.62] for every decade increase in age, P < 0.01) were at a higher risk of RRD, whereas patients with good presenting VA (HR [95% CI] = 0.85 [0.70-0.98] for every 10-letter increase in VA, P = 0.02) were at a lower risk. Neither the type of retinal disease (P = 0.52) nor the VEGF inhibitor (P = 0.09) was significantly associated with RRD risk. Cases with RRD lost 3 lines of vision on average compared with the prior RRD VA and had significantly fewer injections than matched controls over the year after the RRD. Conclusions: Rhegmatogenous retinal detachment is a rare complication of VEGF inhibitor IVT in routine clinical practice with poor visual outcomes at 1 year

Treat-and-Extend Versus Pro re nata Regimens of Ranibizumab and Aflibercept in Neovascular Age-Related Macular Degeneration: A Comparative Study from Routine Clinical Practice

We thank all study investigators of the Fight Retinal Blindness! Study Group: Armadale Eye Clinic, Victoria (Dr A Cohn); Australian Eye Specialists (Bacchus Marsh), Victoria (Dr N Jaross); Blink, Australian Capital Territory (Dr R Barry); Bundaberg Eye Clinic, Queensland (Dr I McLean); CH Saint Brieuc, France (Dr T GUILLAUMIE, Dr A MIRI); CHU de Dijon, France (Dr P GABRIELLE); Centre Ophtalmologique Vincennes Vision, France (Dr S Tick); Cairns Eye Surgery, Queensland (Dr A Field); Camberwell Retina Specialists, Victoria (Dr S Wickremasinghe); Canberra Hospital, Australian Capital Territory (Dr C Dayajeewa, Dr J Wells); Care Foresight, New South Wales (Dr A Dunlop); Central Coast Eye Specialist, New South Wales (Dr S Young); Centre Ophtalmologique de l’Ecole Militaire, France (Dr G MIMOUN); Centre for Eye Research Australia, Victoria (Professor R Guymer); Centro de Ojos de La Coruña, Spain (Dr P Carnota); Clinica Oftalvist Valencia, Spain (Dr R Gallego-Pinazo); Clinica Universidad de Navarra, Spain (Dr A GARCÍA LAYANA, Dr M Saenz-de-Viteri); Coastwide Eye Surgery, New South Wales (Dr R Ferrier); Doncaster Eye Center, Victoria (Dr L Chow); Dorset Consultant Center, Victoria (Dr H Steiner); Dr Alex Amini’s Practice, Victoria (Dr A Amini); Dr Jern Yee Chen Practice, South Australia (Dr J Chen); Dr Niladri Saha GHR, South Australia (Dr N Saha); Dr Niladri Saha MV, South Australia (Dr N Saha); Dr. Phillip Windle, Queensland (Dr P Windle); Eye Associates, New South Wales (Dr M Gillies, Dr A Hunt); Eye Doctors Mona Vale, New South Wales (Dr P Beaumont); Eye Specialists Greensborough, Victoria (Dr L Chow); Eye Surgeons Miranda, New South Wales (Dr A Hunt); Eye Wide Bay, Queensland (Dr Z Louw); Eyeclinic Albury Wodonga, New South Wales (Dr A Luckie); Eyemedics (Wayville), South Australia ( S Lake, Dr D Qatarneh); FPHAG, Spain (Dr L Sararols, Dr J Suarez); Focus Eye Centre, New South Wales (Dr P Berdoukas); Fondazione IRCCS CA’GRANDA—Ospedale Maggiore Policlinico, Italy (Dr F Viola); Gladesville Eye Specialists, New South Wales (Dr S Young); Hospital Universitario Principe de Asturias, Spain (Dr R Montejano Milner, Dr C Arruabarrena); Hawthorn Eye Clinic, Victoria (Dr L Chow); Hospital Clinico Universitario Lozano Blesa, Spain (Dr F ASCASO, Dr A BonedBoned Murillo, Dr M DÍAZ, Mr G PEREZ RIVASES); Hospital Clínic de Barcelona, Spain (Ms S Alforja Castiella, Dr R Casaroli-Marano, Dr M Figueras-Roca, Mr J Zarranz-Ventura); Hospital Costa del Sol, Spain (Dr S GISMERO MORENO, Dr A González Escobar, Mr J Moreno Gutiérrez); Hospital Dos de Maig, Spain (Dr j escobar ); Hospital Punta de Europa, Spain (Dr F Lavid); Hospital San Juan de Dios del Aljarafe, Spain (Dr P Catalán Muñoz, Dr M Tena Sempere); Hospital Tor Vergata Roma, Italy (Professor F RICCI); Hospital Universitari Germans Trias i Pujol, Spain (Dr L Broc Iturralde, Dr S Gómez Sánchez ); Hospital Universitario Basurto, Spain (Dr G GARAY-ARAMBURU); Hospital Universitario Fundacion Jimenez Diaz, Spain (Mrs N Munoz Sanz); Hospital Universitario Miguel Servet, Spain (Dr P CALVO, Dr J Sanchez); Hospital Universitario Puerta de Hierro, Spain (Dr E Almazan Alonso, Mrs M Garcia Zamora); Hospital Universitario Ramon y Cajal, Support Spain (Dr E Ciancas, Dr J GONZALEZ-LOPEZ); Hospital Universitario de Bellvitge, Spain (Dr D Lorenzo); Hospital Universitario de La Princesa, Spain (Dr m Acebes, Dr S Aparicio-Sanchis); Hospital Universitario del Henares, Spain (Dr A Fernández Hortelano); Hospital Universitario del Vinalopo, Spain (Dr A Piñero Sánchez); Hospital de Torrevieja, Spain (Dr L García García, Dr E Salinas Martínez); Hospital do Meixoeiro, Spain (Dr A CAMPO GESTO, Dr M Rodriguez Núñez); Les Manning, Queensland (Dr L Manning); Luigi Sacco Hospital—University of Milan, Italy (Dr A Invernizzi); Maison rouge Ophthalmologic center, France (Dr L Castelnovo, Dr G Michel, Dr B Wolff); Mark Perks clinic, South Australia (Dr M Perks); Marsden Eye Specialists, New South Wales (Dr J Arnold, Dr H Cass); Mater Private Hospital, Ireland (Dr L OToole); Midwest Ophthalmology, New South Wales (Dr K Tang); Mona Vale Eye Centre, New South Wales (Dr C Chung); Montpellier CHU, France (Professor V DAIEN); Mosman Eye Centre, New South Wales (Dr C Chung); Nepean Valley Eye Surgeons, New South Wales (Dr G Banerjee); New England Eye Centre, New South Wales (Dr M Morgan); Port Macquarie Eye Centre, New South Wales (Dr J Game, Dr C Thompson); Retina & Macula Specialists (Hurstville), New South Wales (Dr R Chalasani, Dr M Chilov, Dr A Fung, Dr S Nothling ); Retina & Macula Specialists (Miranda), New South Wales (Dr M Chilov, Dr S Nothling ); Retina Associates, New South Wales (Dr R Chong, Dr S Fraser-Bell, Dr A Fung, Dr C Younan); Southern Eye Centre, Victoria (Dr D Louis); Specialist Eye Group, Victoria (Dr L Chow, Dr A Cohn); St John of God Hospital Geelong, Victoria (Dr P Lockie); Strathfield Retina Clinic, New South Wales (Dr C Chung, Dr J Wong); Sydney Eye Hospital, New South Wales (Dr R Chong, Dr S Fraser-Bell, Dr M Gillies); Tamworth Eye Centre, New South Wales (Dr P Hinchcliffe); University Hospital Zurich, Switzerland (Dr D Barthelmes); Unidad de Gestion Clinica de Oftalmologia, Hospital de Txagorritxu, Spain (Dr E DIAZ DE DURANA SANTA COLOMA, Dr G GARAY-ARAMBURU); University Hospital Maggiore della Carita, Italy (Dr S Vujosevic); Vall de Hebron University Hospital, Spain (Dr H Brosa Morros); Victoria Parade Eye Consultants, Victoria (Professor R Guymer, Dr A Harper, Dr J ODay); Victorian Eye Surgeons, Victoria (Dr A Cohn); Visionary Eye Specialists, New South Wales (Dr C Hooper); Dr Maria Jose Rodríguez Cid, Hospital de Conxo, Spain.International audienceIntroduction: Anti-vascular endothelial growth factor (VEGF) is generally given using pro re nata or "treat-and-extend" (T&amp;E) regimens for neovascular age-related macular degeneration (nAMD). Randomized clinical trials have reported that T&amp;E is superior to Pro re nata (PRN), but results from clinical trials may not always be replicated in clinical practice. Real-world data comparing T&amp;E and PRN regimens for nAMD are limited. The objective of this work was to report 24-month outcomes of PRN versus T&amp;E regimens for ranibizumab and aflibercept to treat nAMD in routine clinical practice. Methods: We conducted a retrospective analysis of data from a prospectively designed observational outcomes registry, the Fight Retinal Blindness! Project (FRB). Treatment-naive eyes starting nAMD treatment with at least three injections using a T&amp;E or PRN regimen were tracked by using the FRB. The primary outcome was the mean change in visual acuity (VA) measured by the number of letters read on a logarithm of the minimum angle of resolution chart at 2 years versus baseline. The secondary outcome was the number of injections at 2 years. Results: From January 1, 2015 to January 31, 2019, 3313 eyes from 2948 patients with nAMD were included: 1243 eyes from 1065 patients were classified as PRN and 2070 eyes from 1935 patients started a T&amp;E regimen. At 24 months, patients on the T&amp;E regimen experienced significantly greater mean (95% confidence interval) improvement in VA than those on PRN (+ 4.2 [3.1, 5.2] vs. + 1.3 [0.1, 2.6] letters; p &lt; 0.001), with more injections (14.9 standard deviation(SD) 4.3) vs. 9.8(SD 4.3); p &lt; 0.001). Conclusions: Eyes treated with a T&amp;E regimen had better VA outcomes from VEGF inhibitors than eyes treated PRN. This large real-world data assessment supports previous data from randomized clinical trials that the T&amp;E regimen delivers better outcomes than PRN

Treatment patterns and visual outcomes during the maintenance phase of treat-and-extend therapy for age-related macular degeneration

PURPOSE: To present the treatment patterns, disease activity, and visual outcomes of eyes in the maintenance phase of a treat-and-extend regimen for neovascular age-related macular degeneration (nAMD). To compare the maintenance phase behavior of eyes with a shorter induction phase (≤3 injections) with those requiring a longer induction phase (>3 injections). DESIGN: Database observational study. PARTICIPANTS: Eyes with nAMD receiving anti-vascular endothelial growth factor (VEGF) treatment using a treat-and-extend protocol. Persistently active eyes were excluded, as were eyes with <12 months follow-up during the maintenance phase. METHODS: Clinical information from a large prospective international voluntary registry of nAMD was analyzed. The maintenance phase was defined as starting at the first clinician-reported grading of lesion inactivity. MAIN OUTCOME MEASURES: For analyses by eye: treatment interval at first reactivation; time to first reactivation; and visual acuity change during the study period. For analyses by visit: choroidal neovascular membrane activity graded by the treating physician; time since previous injection; and visual acuity loss since previous injection (>0 letters and ≥15 letters). RESULTS: The mean change in visual acuity during the maintenance phase was +1.0 letters at 12 months -0.6 letters at 24 months and -1.5 at 36 months. Median treatment interval increased from 35 days at study entry to 63 days at 12 months and was 60 days at 36 months. 38.5% of eyes remained inactive at all observed visits during the maintenance phase (minimum 1 year follow-up, mean 945 days). The most common treatment interval at first reactivation was 8 weeks. Treatment intervals beyond 12 weeks seemed to be associated with increased risk of disease reactivation, with risk of reactivation reaching 37.4% at treatment intervals of ≥20 weeks. Eyes with a longer induction phase had worse visual outcomes in the maintenance phase, and earlier and more-frequent disease reactivation, although they received injections less frequently. CONCLUSIONS: The detailed behavior of eyes in the maintenance phase of treat-and-extend management for nAMD is presented. Visual acuity was well maintained during the study period. The most common interval at which reactivation first occurred was 8 weeks. Longer duration of induction phase was associated with worse visual acuity outcomes and earlier disease reactivation, perhaps because of undertreatment

Two Year Outcomes of "Treat And Extend" Intravitreal Therapy Using Aflibercept Preferentially for Neovascular Age-Related Macular Degeneration

International audiencePURPOSE:To report 24-month outcomes of a treat and extend (T&E) regimen using aflibercept in eyes with neovascular age-related macular degeneration.METHODS:This was a database observational study that included treatment-naive eyes with neovascular age-related macular degeneration tracked by the Fight Retinal Blindness! outcome registry completing 24 months of sole monotherapy with aflibercept treatment under a T&E regimen between November 1, 2012 and January 31, 2014. Locally weighted scatterplot smoothing curves were used to display visual acuity outcomes. Main outcome measures were change in visual acuity at 24 months and number of injections and visits during the study period.RESULTS:The study population, identified by reviewing the database, consisted of 136 eyes from 123 patients completing 24 months of follow-up on aflibercept. Mean (SD) age was 77.2 (7.0) years, 59% were female. Mean visual acuity increased from 61.4 (∼20/60; SD 17.4) letters at baseline to 67.4 (∼20/45; SD 17.7) letters at 24 months (+6.0 letters [95% confidence interval: 3.3-8.5]; P < 0.001). From baseline to 24 months, the proportion of eyes with visual acuity ≥70 letters (20/40) increased (40%-58%, P < 0.001) and the proportion of eyes with visual acuity ≤35 letters (20/200) remained the same (10%; P = 0.547). Ninety-eight per cent of eyes starting with visual acuity ≥70 letters (20/40) were able to maintain this up to 24 months. From the first to the second year of treatment, the mean number of injections (7.8 [2.1] vs. 5.7 [2.6]; P < 0.001) and visits (8.7 [1.7] vs. 6.5 [2.4]; P < 0.001) decreased for eyes completing 24 months of treatment. When data from 60 eligible eyes that did not complete 2 years follow-up, along with 14 eyes that switched to ranibizumab, were included using last observation carried forward, the mean change in visual acuity from baseline was +5.6 letters (95% confidence interval: 3.3-7.7).CONCLUSION:These data indicate that eyes treated with aflibercept, as a sole therapy, in routine clinical practice with a T&E regimen can achieve good visual outcomes while decreasing the burden of treatments and clinic visits

One-year anti-VEGF therapy outcomes in diabetic macular edema based on treatment intensity: Data from the FRB! registry

Fight Retinal Blindness! Investigators.International audiencePurposeTo compare one-year outcomes of eyes with diabetic macular edema (DME) treated in routine clinical practice based on the proportion of visits where intravitreal vascular endothelial growth factor (VEGF) inhibitor injections were delivered.DesignCohort studyParticipantsThere were 2288 treatment-naïve eyes with DME starting intravitreal VEGF inhibitor therapy from 31 October 2015 to 31 October 2021 from the Fight Retinal Blindness! international outcomes registry.MethodsEyes were grouped according to the proportion of visits at which an injection was received, Group A with less than the median of 67% (n=1172) versus Group B with greater than the median (n=1116).Main Outcome MeasureMean visual acuity (VA) change after 12 months of treatment.ResultsThe mean (95% confidence interval [CI]) VA change after 12 months of treatment was 3.6 (2.8, 4.4) letters for eyes in Group A versus 5.2 (4.4, 5.9) letters for eyes in Group B (p=0.005). The mean (95% CI) central subfield thickness (CST) change was -69 (-76, -61) μm and -85 (-92, -78) μm for eyes in Group A versus Group B, respectively (p=0.002). A moderate positive correlation was observed between the number of injections received over 12 months of treatment and the change in VA (p&lt;0.001). Additionally, eyes that received more injections had a moderately greater CST reduction.ConclusionsThis registry analysis found that overall VA and anatomic outcomes tended to be better in DME eyes treated at a greater proportion of visits in the first year of intravitreal VEGF inhibitor therapy

One-Year Anti-VEGF Therapy Outcomes in Diabetic Macular Edema Based on Treatment Intensity: Data from the Fight Retinal Blindness! Registry.

PURPOSE: To compare 1-year outcomes of eyes with diabetic macular edema (DME) treated in routine clinical practice based on the proportion of visits where intravitreal VEGF inhibitor injections were delivered. DESIGN: Cohort study. PARTICIPANTS: There were 2288 treatment-naive eyes with DME starting intravitreal VEGF inhibitor therapy from October 31, 2015 to October 31, 2021 from the Fight Retinal Blindness! international outcomes registry. METHODS: Eyes were grouped according to the proportion of visits at which an injection was received, Group A with less than the median of 67% (n = 1172) versus Group B with greater than the median (n = 1116). MAIN OUTCOME MEASURES: Mean visual acuity (VA) change after 12 months of treatment. RESULTS: The mean (95% confidence interval [CI]) VA change after 12 months of treatment was 3.6 (2.8-4.4) letters for eyes in Group A versus 5.2 (4.4-5.9) letters for eyes in Group B (P = 0.005). The mean (95% CI) central subfield thickness (CST) change was -69 (-76 to -61) μm and -85 (-92 to -78) μm for eyes in Group A versus Group B, respectively (P = 0.002). A moderate positive correlation was observed between the number of injections received over 12 months of treatment and the change in VA (P < 0.001). Additionally, eyes that received more injections had a moderately greater CST reduction. CONCLUSIONS: This registry analysis found that overall VA and anatomic outcomes tended to be better in DME eyes treated at a greater proportion of visits in the first year of intravitreal VEGF inhibitor therapy. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article